General practitioners' management of problem drinkers - attitudes, knowledge and practice

There is evidence that GPs frequently fail to identify problem drinkers and many are ambivalent about treating them. This study investigated GPs' perc eptions of the numbers of their patients with alcohol problems; how they di agnose problem drinkers and their knowledge and attitudes; GPs' perceived r oles and part in management. Fifty GPs were interviewed. Reported rates of detection and treatment of problem drinkers were lower than expected, and r eferral was the most popular management strategy. Screening occurred most f requently at registration or was opportunistic. When characterizing and dia gnosing alcohol misuse, GPs emphasized social rather than health or psychol ogical problems. They found it easier to broach the subject of alcohol misu se when there was objective evidence of damage to health. Knowledge of the local alcohol services was good. Although most considered general practice an appropriate place to treat problem drinkers and nearly all believed it w as legitimate to inquire about patients' drinking, 70% said they would like more training. Most of the GPs found work with problem drinkers unrewardin g, and 40% admitted to not liking drinkers. Complaints of lack of time were frequent. These findings indicate little change since the late 1980s. More GPs appear to be screening patients for problem drinking, but few are them selves treating those identified. GPs need more training and support to man age these patients in general practice but a more realistic appraisal may b e required of what GPs themselves can provide.